Total shoulder replacement sugery: An expert's guide

In his latest online article, Mr Andrew Chambler gives us his insights into total shoulder replacement surgery. He explains what it is, the common conditions, the procedure, the risks and the long-term outcomes.

What is total shoulder replacement surgery and when it is recommended as a treatment option?

 Total shoulder replacement surgery is mainly for patients who have pain and restriction of their shoulder. It tends to be more common in the elderly when the joint is worn out and the commonest reason for doing this is for shoulder arthritis. There are several types of arthritis, but essentially, they all end up with patients suffering from pain and stiffness.

What are the common conditions or injuries that would require total replacement surgery?

The typical circumstances under which shoulder replacement surgery might be considered, discussed, or entertained primarily involve arthritis. Occasionally, we can find in elderly patients that the tendons around the shoulder or inside the shoulder are also torn and that gives rise to pain and disability and they can also be considered for surgery.

There are two primary types of shoulder surgery or shoulder replacements: anatomic and reverse.

In an anatomic shoulder replacement, the damaged ball and socket are replaced with a metal ball and socket respectively, provided the tendons are intact.

However, if the tendons are torn, a reverse shoulder replacement is performed, wherein the ball and socket aspects are reversed to create a fulcrum for the remaining muscles, particularly the deltoid muscle, to enable shoulder function.

Can you explain how is the procedure of this shoulder replacement and what are the expected outcomes in terms of pain and improved functioning and mobility?

Regarding the replacement procedure, patients typically stay overnight. They arrive in the morning and undergo assessment by the anaesthesia team to prepare for surgery. The operation, performed under general anaesthesia, typically lasts between one to one and a half hours. An incision is made at the front of the shoulder to expose the joint, allowing us to carry out the replacement with either the anatomic or reverse approach, depending on their specific condition.

Are there any specific risks and complications associated with this kind of surgery? 

Shoulder replacement does carry some risks; however, fortunately, these occurrences are very uncommon. The risks are comparable to other joint replacements, like hip and knee surgeries, concerning potential anaesthesia-related concerns, the risk of infection, or inadvertent damage to surrounding structures during the operation.

However, these complications happen very rarely, accounting for less than 1% of cases. Additionally, there is a possibility of implant dislocation or gradual wear-out, which may necessitate revision surgery, but this is observed in less than 5% of cases. Overall, these issues are thankfully infrequent occurrences.

How does the rehabilitation process deeply unfold after this procedure?

After the surgery, patients receive guidance from the hospital physiotherapist, who provides them with a set of exercises. For the initial three weeks, while wearing a sling, they perform gentle exercises to promote wound healing and allow the affected structures to stabilize.

Subsequently, they will continue their rehabilitation with a community-based physiotherapist. This phase focuses on exercises to strengthen the muscles that are now required for use and to regain their range of motion. Typically, patients undergo regular physiotherapy sessions for around three months.

Afterward, they continue with home exercises for about six months to ensure they achieve the full benefits and optimal surgical outcomes. This comprehensive approach to physiotherapy enhances the chances of a successful recovery.

What are the long-term outcomes, success rate of this kind of surgery?

Shoulder surgery boasts favourable success rates and yields promising long-term outcomes. Based on studies and patient follow-ups recorded in joint registries, well over 80 to 90% of replacements remain functional and effective even after 18 to 20 years.

While a small percentage of cases may require revisions, the results of these revision surgeries have proven to be successful. Moreover, advancements in technology have been instrumental in continuously improving the longevity of shoulder replacements.

As we adopt and implement the latest technologies, the durability and overall performance of shoulder replacements continue to evolve, instilling further confidence in the procedure's effectiveness.

Mr Andrew Chambler is a highly respected Specialist shoulder and elbow orthopaedic surgeon with more than 20 years of experience. You can book an appointment with Mr Chambler today on his Top Doctor’s profile.